Women and psychiatry

Life size wax head of a melancholy insane woman, England, 1910-1950

Psychiatry emerged as a medical speciality in Europe at the beginning of the 1800s. However, women’s suffrage was over a century away. Most people, psychiatrists included, believed a woman’s place was in the home. She should be subordinate to her husband and dedicated to maternal and domestic responsibilities. Women’s roles have since profoundly changed in many parts of the world. Psychiatry has changed as a result.

Victorian women and asylum reform

A woman who rebelled against Victorian domesticity risked being declared insane and committed to an asylum. This was usually at her husband’s or father’s request, and she generally had no right to contest or appeal. Women were further disempowered by moral treatment once locked away. This cornerstone of Victorian psychiatry claimed male dominance was therapeutic. The doctor ruled the asylum like a father ruled his family.

The spread of asylums between 1800 and 1900 surprisingly enabled a few women to be heard in politics. Elizabeth Packard won freedom after being confined to an asylum by her husband. She wrote a bestselling exposé, and advocated asylum reform and women’s rights. Dorothea Dix lobbied successfully for public asylums throughout the US and UK. Some scholars argue Victorian readers became more outraged by the mistreatment of ‘madwomen’ than the mistreatment of ‘madmen’. This may have been a response to the stereotyped ‘madwoman in the attic’ in novels of the time.

Hysteria and psychoanalysis

Nearly all Victorian physicians considered women more fragile and sensitive than men. They believed women were more susceptible to nervous breakdown and neurasthenia. The classic ‘female malady’ was hysteria. This diagnosis covered strange behaviours and nerve symptoms found most often in women, but also sometimes in ‘feminine’ men. The most commonly prescribed treatment for an unmarried woman showing signs of hysteria was to find a husband.

Physicians had discussed hysterical symptoms for millennia. However, it took until the late 1800s for ‘hysteria’ to become a specific disease and the focus of intense medical attention. In the 1880s, Jean-Martin Charcot proposed hysteria was a nerve disease like multiple sclerosis. He said it was not a ‘sexual problem’ unique to women. Sigmund Freud studied briefly with Charcot in 1885. He developed the theory that hysteria was rooted in unconscious emotional conflicts rather than weak nerves. Unlike Charcot, Freud listened carefully to patients. He recorded whatever they talked about, looking for clues to their symptoms. One early patient, Bertha Pappenheim (Anna O), called this the ‘talking cure’. It became a nickname for psychoanalysis.

Feminism and change

Many women’s lives in the 1960s and 1970s were still organised around Victorian stereotypes of the loving mother and dutiful housewife. Influential feminist writers of the time criticised psychiatry. They argued it was one of the main ways society controlled women. Women who did not behave ‘properly’ risked ending up in psychiatric care. Many feminist writers also criticised psychoanalysis, the then-dominant approach in psychiatry. They argued Freud’s focus on sexual fantasies, and the fact that most of his patients were women, rehashed old ideas. It was similar to hysteria being labelled a ‘women’s problem’ that should be cured by finding a man.

Another psychiatric therapy that drew feminist attention was the class of drugs called minor tranquilisers. The most famous was diazepam, introduced in 1963 under the trade name Valium. It became known as ‘mother’s little helper’, after a song by the Rolling Stones. Concerns about minor tranquilisers being addictive arose in the late 1960s. Anecdotes about ‘smartly dressed junkies’ and ‘medical addicts’ appeared in mainstream women’s magazines and advice columns throughout the 1970s. Some scholars have recently argued the danger was overstated, but such media attention brought feminist criticisms of psychiatry to a broader audience. This included women who did not think of themselves as ‘feminists’.

The popularity of minor tranquilisers reflected how many women in the 1960s and 1970s felt dissatisfied with their lives. It also suggested many women were bowing to pressure from usually male psychiatrists. Their dissatisfaction was treated as a medical problem rather than a spur to political change. Feminist writers warned psychiatric drugs could silence women, as asylums had. Antidepressants have since overshadowed minor tranquilisers. Psychiatrists, many of them women, remain mindful of this history.